Provider Demographics
NPI:1427146760
Name:UNIVERSAL PEDIATRICS, INC.
Entity type:Organization
Organization Name:UNIVERSAL PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NKEM
Authorized Official - Middle Name:VESTA
Authorized Official - Last Name:NNAETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-674-0036
Mailing Address - Street 1:169-177 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3430
Mailing Address - Country:US
Mailing Address - Phone:973-674-0036
Mailing Address - Fax:973-674-0322
Practice Address - Street 1:169-177 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3430
Practice Address - Country:US
Practice Address - Phone:973-674-0036
Practice Address - Fax:973-674-0322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7065906Medicaid
NJF65166Medicare UPIN